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ASHA periodically receives member inquiries regarding the appropriateness of missing a treatment session that falls on a federal holiday. The Medicare fiscal intermediary should be contacted to determine if a local policy exists regarding treatment during a holiday. There is a somewhat relevant instruction about breaks in rehabilitation service from the federal Medicare program.
The Centers for Medicare and Medicaid Services (CMS) issued guidance (Federal Register, 7/30/99, p. 41670) for maintaining coverage in a skilled nursing facility (SNF) that requires receipt of skilled services at least five days per week:
". . . the Medicare program does not specify in regulations or guidelines an official list of holidays or other specific occasions that a facility may observe as breaks in rehabilitation services . . . The facility itself must judge whether a brief, temporary pause in the delivery of therapy services would adversely affect the resident's condition."
However, this guidance is not definitive because it was in response to situations where a SNF resident initiated a brief absence to attend an event with family or friends. It also does not respond to a specific plan of care that calls for 5 treatments per week.
Additional information about Medicare reimbursement can be found on the ASHA Web site. Questions about this subject can be directed to Mark Kander, ASHA’s Director of Health Care Regulatory Analysis, at reimbursement@asha.org.
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